Pneumothorax and Pneumatocoele Formation in a Patient with COVID-19: a Case Report

Coronavirus disease 2019 (COVID-19) causes significant morbidity and mortality for a proportion of infected patients, and our knowledge and understanding of its clinical, radiological and histopathological features are still evolving. An association between COVID-19 and pneumothorax has been described in an increasing number of case reports and series in the literature, which have largely focused on clinical and imaging features. We report the case of a patient who developed COVID-19 complicated by pneumothorax, requiring surgical intervention. We describe the histopathological features seen in the thorascopically resected bullectomy specimen—this is, to our knowledge, the first reported description of the morphological features of pneumothorax in this important clinical setting.

Type II Cryoglobulinaemia causing Monoclonal Gammopathy of Renal Significance

A 53 year old female with a background of hypertension, hypothyroidism and Raynaud's was admitted with an acute ischaemic stroke and referred to the renal team after a routine urine dip revealed microscopic haematuria and nephrotic-range proteinuria. Blood tests revealed renal impairment, a monoclonal IgM kappa paraprotein, low complement C4 concentration and a positive rheumatoid factor. Active cryoglobulinaemia was suspected and testing demonstrated type II cryoglobulins secondary to the monoclonal IgM kappa paraprotein. Bone marrow biopsy was normal. Renal biopsy revealed cryoglobulinaemia associated membranoproliferative glomerulonephritis. Treatment with steroids and rituximab improved renal function and proteinuria. This case fits within the evolving spectrum of disorders now termed Monoclonal Gammopathy of Renal Significance and highlights the value of biopsying and treating these patients early.

Syphilis masquerading as focal segmental glomerulosclerosis

A patient referred to the genitourinary clinic for positive syphilis serology was found to have symptoms and signs of nephrotic syndrome. A renal biopsy showed focal segmental glomerulosclerosis (FSGS). Doxycycline 200 mg twice daily for 28 days coincided with considerable decrease in proteinuria and rise in serum albumin, suggesting a causal relationship.

Banff '05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy ('CAN')

The 8th Banff Conference on Allograft Pathology was held in Edmonton, Canada, 15-21 July 2005. Major outcomes included the elimination of the non-specific term "chronic allograft nephropathy" (CAN) from the Banff classification for kidney allograft pathology, and the recognition of the entity of chronic antibody-mediated rejection. Participation of B cells in allograft rejection and genomics markers of rejection were also major subjects addressed by the conference.

Sarcoid tubulo-interstitial nephritis: Long-term outcome and response to corticosteroid therapy

Sarcoidosis is a chronic relapsing multi-systemic disorder characterized by the development of non-caseating granulomas. Granulomatous tubulo-interstitial nephritis is an uncommon manifestation of this condition. We identified 39 patients with sarcoidosis and renal disease from a single center of whom 17 patients had biopsy-proven tubulo-interstitial nephritis. They were analyzed with respect to demographic and clinical features, including response to corticosteroids and length of follow-up. They all presented with significant renal impairment. At presentation the mean+/-s.d. estimated glomerular filtration rate (eGFR) was 26.8+/-14 ml/min by modification of diet in renal disease (MDRD) equation 7. With treatment there was a significant improvement in renal function with eGFR 49.6+/-5.2 ml/min (P<0.01) at 1 year, and 47.9+/-6.8 ml/min (P<0.05) at the last review. The median follow-up was 84 months (range 6-284 months). Patients with chronic kidney disease (CKD) 3, the mean eGFR was 38.30+/-2.4 ml/min at presentation and 60.2+/-7.4 ml/min at 1 year (P=0.02) and in CKD 4 it improved from 19+/-2 to 38+/-6.6 ml/min at 1 year (P<0.05). After the 1st year, the change in eGFR was +0.8 ml/min/year for CKD 3 and -2 ml/min/year for CKD 4 (P<0.05). Three patients ceased their therapy either due to complications or poor compliance and experienced a worsening of renal function which was then reversed on re-commencing corticosteroids. Corticosteroids are effective in advanced tubulo-interstitial nephritis due to sarcoidosis. Long-term treatment is necessary to preserve renal function and to delay the onset of end-stage renal disease.

Measurement of the D(s)+ lifetime

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.

Always look beyond the stones: hyperoxaluria overlooked

We report a case which demonstrates the disastrous consequences of late diagnosis of hyperoxaluria in a 24-year-old woman with nephrocalcinosis, a staghorn calculus and recurrent urinary tract infections. Her initial management at another hospital included multiple percutaneous nephrostomies and lithropsies. Metabolic screening was not undertaken. Hyperoxaluria was finally diagnosed by elevated urine oxalate (1.235 mmol/24 h) and renal biopsy, by which time there was already significant reduction of renal function. A diagnosis of hyperoxaluria type I was confirmed by liver biopsy. Despite starting pyridoxine and crystallization inhibitors, her renal function deteriorated, requiring hemodialysis and she was referred for combined liver-renal transplantation. Clinical clues of primary hyperoxaluria type I are a positive family history or presentation with severe renal stones at an unusually early age. Irrespective of the above, all patients with first presentation of renal calculi should undergo metabolic screening, including urine oxalate.

Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook

The aim of this study was to investigate the incidence and clinicopathological features of angiosarcoma of the breast by focusing on those cases passing through a busy general teaching hospital over a 30 year period. A search was carried out of all cases in the files of the Department of Pathology of the Royal London Hospital from 1970 to 2000. Four cases were identified as primary angiosarcomas involving the breast. The medical and surgical histories, macroscopic and microscopic features and clinical outcome with long-term follow-up are described in each case. Similarities were identified, such as initial presentation with a 'bruise' and a latent period before the diagnosis was established. Half of our cases followed irradiation for breast cancer. In all cases the prognosis after surgery was excellent. The rarity of primary mammary angiosarcoma was confirmed. In younger patients the lesion was not associated with previous radiotherapy, but the older patients presented after radiotherapy for adenocarcinoma of the breast. Although very uncommon, these tumours must be considered in the differential diagnosis, especially with the increasing use of fine-needle-aspiration and core biopsy for preoperative diagnosis. The prognosis after complete surgical excision may be better than generally believed.

Dalitz plot analysis of the decay D(+)-->K(-)pi(+)pi(+) and indication of a low-mass scalar Kpi resonance

We study the Dalitz plot of the decay D(+)-->K(-)pi(+)pi(+) with a sample of 15090 events from Fermilab experiment E791. Modeling the decay amplitude as the coherent sum of known Kpi resonances and a uniform nonresonant term, we do not obtain an acceptable fit. If we allow the mass and width of the K(*)(0)(1430) to float, we obtain values consistent with those from PDG but the chi(2) per degree of freedom of the fit is still unsatisfactory. A good fit is found when we allow for the presence of an additional scalar resonance, with mass 797+/-19+/-43 MeV/c(2) and width 410+/-43+/-87 MeV/c(2). The mass and width of the K(*)(0)(1430) become 1459+/-7+/-5 MeV/c(2) and 175+/-12+/-12 MeV/c(2), respectively. Our results provide new information on the scalar sector in hadron spectroscopy.

A high statistics measurement of the Lambda(+)(c) lifetime

A high statistics measurement of the Lambda(+)(c) lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis technique with particular attention to the determination of the systematic uncertainty. The measured value of 204.6 +/- 3.4 (stat) +/- 2.5 (syst) fs from 8034 +/- 122 Lambda(+)(c)-->pK(-)pi(+) decays represents a significant improvement over the present world average.

Search for CP violation in the decays D+--> K(S)pi+ and D+-->K(S)K+

A high-statistics sample of photoproduced charm from the FOCUS experiment has been used to search for direct CP violation in the decay rates for D+-->K(S)pi+ and D+-->K(S)K+. We have measured the following asymmetry parameters relative to D+-->K-pi+pi+: A(CP)(K(S)pi+) = (-1.6+/-1.5+/-0.9)%, A(CP)(K(S)K+) = (+6.9+/-6.0+/-1.5)%, and A(CP)(K(S)K+) = (+7.1+/-6.1+/-1.2)% relative to D+-->K(S)pi+. We have also measured the relative branching ratios and found Gamma(D+-->K(0)pi+)/Gamma(D+-->K-pi+pi+) = (30.60+/-0.46+/-0.32)%, Gamma(D+-->K(0)K+)/Gamma(D+-->K-pi+pi+) = (6.04+/-0.35+/-0.30)%, and Gamma(D+-->K(0)K+)/Gamma(D+-->K(0)pi+) = (19.96+/-1.19+/-0.96)%.

Secondary neoplasms of the breast: a survey of the 20th Century

BACKGROUND

A 90-year archive of surgical and postmortem material was reviewed to establish the incidence, presentation, and pathology of tumors secondary to the breast.

METHODS

A search was performed on all cases contained within the files of the Pathology Department of the Royal London Hospital from 1907 to 1999.

RESULTS

Sixty patients were identified with unequivocal, secondary, nonmammary neoplasms involving the breast. Hematologic tumors predominated, particularly among the more recent cases, with carcinoma less frequent overall but more numerous in the earlier part of the 20th century. There were several surprising and sometimes unique findings, with occasional metastases from primary tumors of the esophagus, retina, pancreas, thyroid, and skin. Other primary tumor sites included the stomach, lungs, and kidney. In line with expectations, the majority of tumors occurred in women.

CONCLUSIONS

Secondary tumors to the breast are rare. In the current series, these tumors comprised 3% of the breast tumors in the files under review. The majority of these were metastases from the contralateral breast. However, the existence of metastatic nonmammary tumors to the breast should be appreciated so that secondary tumors from unusual sites are not overlooked, particularly with the widespread use of fine-needle aspiration cytology and needle core biopsies for preoperative diagnosis. In fact, 0.43% of the breast malignancies in the current report originated from sites outside the breast. Of these one-third represented spread from an occult primary. Furthermore, the current data suggest a move from carcinomatous metastases to hematologic malignancies over the last century, possibly reflecting earlier diagnosis of the former and an increase in the prevalence of the latter.

Measurement of the branching ratios of D(+) and D(+)(s) hadronic decays to four-body final states containing a K(S)

We have studied hadronic four-body decays of D(+) and D(+)(s) mesons with a K(S) in the final state using data recorded during the 1996-1997 fixed-target run of the Fermilab high energy photoproduction experiment FOCUS. We report a new branching ratio measurement of gamma(D(+)-->K(S)K-pi(+)pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0768+/-0.0041+/-0.0032. We make the first observation of three new decay modes with branching ratios gamma(D(+)-->K(S)K+pi(+)pi(-))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0562+/-0.0039+/-0.0040, gamma(D(+)-->K(S)K+K-pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0077+/-0.0015+/-0.0009, and gamma(D(+)(s)-->K(S)K+pi(+)pi(-))/gamma(D(+)(s)-->K(S)K-pi(+)pi(+)) = 0.586+/-0.052+/-0.043, where in each case the first error is statistical and the second error is systematic.

Observation of color-transparency in diffractive dissociation of pions

We have studied the diffractive dissociation into dijets of 500 GeV/c pions scattering coherently from carbon and platinum targets. Extrapolating to asymptotically high energies (where t(min)-->0), we find that when the per-nucleus cross section for this process is parametrized as sigma = sigma0Aalpha, alpha has values near 1.6, the exact result depending on jet transverse momentum. These values are in agreement with those predicted by theoretical calculations of color-transparency.

Direct measurement of the pion valence-quark momentum distribution, the pion light-cone wave function squared

We present the first direct measurements of the pion valence-quark momentum distribution which is related to the square of the pion light-cone wave function. The measurements were carried out using data on diffractive dissociation of 500 GeV/c pi(-) into dijets from a platinum target at Fermilab experiment E791. The results show that the /q&q> light-cone asymptotic wave function describes the data well for Q2 approximately 10 (GeV/c)(2) or more. We also measured the transverse momentum distribution of the diffractive dijets.

Search for rare and forbidden Charm Meson decays D0 --> Vl+l- and hhll

We report results of a search for flavor-changing neutral current (FCNC), lepton flavor, and lepton-number violating decays of the D0 (and its antiparticle) into three and four bodies. Using data from Fermilab charm hadroproduction experiment E791, we examine modes with two leptons (muons or electrons) and a rho(0), K( *0), or straight phi vector meson or a nonresonant pi(pi), Kpi, or KK pair of pseudoscalar mesons. No evidence for any of these decays is found. Therefore, we present branching-fraction upper limits at 90% confidence level for the 27 decay modes examined (18 new).

Study of the decay D0 --> K+pi-

Using a large sample of photoproduced charm mesons from the FOCUS experiment at Fermilab (FNAL-E831), we observe the decay D0-->K+pi- with a signal yield of 149+/-31 events compared to a similarly cut sample consisting of 36 760+/-195 D0-->K-pi+ events. We use the observed ratio of D0-->K+pi- to D0-->K-pi+ (0.404+/-0.085+/-0.025)% to obtain a relationship between the D0 mixing and doubly Cabibbo suppressed decay parameters.

Study of the D(+)(s)-->pi(-)pi(+)pi(+) decay and measurement of f(0) masses and widths

From a sample of 848+/-44 D(+)(s)-->pi(-)pi(+)pi(+) decays, we find gamma(D(+)(s)-->pi(-)pi(+)pi(+))/gamma(D(+)(s)-->straight phipi(+)) = 0.245+/-0.028(+0.019)(-0.012). Using a Dalitz plot analysis of this three body decay, we find significant contributions from the channels rho(0)(770)pi(+), rho(0)(1450)pi(+), f(0)(980)pi(+), f(2)(1270)pi(+), and f(0)(1370)pi(+). We also present the values obtained for masses and widths of the resonances f(0)(980) and f(0)(1370).

Experimental evidence for a light and broad scalar resonance in D(+) --> pi(-)pi(+)pi(+) decay

From a sample of 1172 +/- 61 D(+)-->pi(-)pi(+)pi(+) decays, we find gamma(D(+)-->pi(-)pi(+)pi(+))/gamma(D(+)-->K-pi(+)pi(+)) = 0.0311 +/- 0.0018(+0.0016)(-0.0026). Using a coherent amplitude analysis to fit the Dalitz plot of these decays, we find strong evidence that a scalar resonance of mass 478(+24)(-23) +/- 17 MeV/c(2) and width 324(+42)(-40) +/- 21 MeV/c(2) accounts for approximately half of all decays.

CMV colitis in early HIV infection

Cytomegalovirus (CMV) colitis is a well recognized complication of advanced HIV disease and is only rarely diagnosed in patients with normal immune function. A case of CMV colitis occurring in early HIV infection is described. Although CMV infection is normally confined to patients with advanced HIV disease, it is possible that a number of contributing factors may have led to clinical disease in this patient. CMV colitis is an important diagnosis to consider in all patients who present with a diarrhoeal illness associated with systemic features, regardless of underlying immunosuppression.

Membranous nephropathy resolving with treatment of bronchial carcinoid tumor

The nephrotic syndrome and membranous nephropathy is well recognized in association with solid tumors, although less is understood of the process that links them. We report a 27-year-old man presenting with the nephrotic syndrome and stage I membranous glomerulonephritis on biopsy. A bilar mass with regional lymphadenopathy was found simultaneously, the histology of which was shown to be an infiltrative atypical bronchial carcinoid tumor. The neoplasm was successfully treated with combined chemotherapy and radiotherapy, and over this period his nephrotic-range proteinuria resolved. As has been described with other malignancies, membranous nephropathy associated with a bronchial carcinoid tumor may resolve with treatment of the underlying condition.

Fatal cardiovascular complication 19 years after treatment for fibrosarcoma

Fibrosarcoma accounts for 3% of all primary bone tumours. It most commonly occurs in the metaphyseal areas of long bones around the knee, and may metastasize to the lungs (Neff, 1991). Here we report a case of a fatal cardiovascular complication 19 years after successful treatment of fibrosarcoma with chemotherapy and radiotherapy.

Appendiceal inflammation in ulcerative colitis

AIMS

Previous uncontrolled reports have suggested that appendiceal inflammation may occur as a discontinuous lesion in ulcerative colitis. This study aims semiquantitatively to compare the prevalence and histological features of appendiceal inflammation in patients with ulcerative colitis and Crohn's disease, using colonic carcinoma and acute appendicitis specimens as controls.

METHODS AND RESULTS

Surgical pathology records and original histological slides for the period 1980-1994 were examined. The prevalence of appendiceal inflammation in ulcerative colitis (24/50, 48%), was higher than in colonic carcinoma (5/65, 8%, P < 0.001), but was similar to that in Crohn's disease (14/27, 52%). Appendiceal inflammation with caecal sparing was seen in nine out of 24 specimens with ulcerative colitis (37%), two out of nine (22%) with Crohn's disease and five out of 65 (8%) with colonic carcinoma. Inflamed appendixes from patients with inflammatory bowel disease showed histological features typical of ulcerative colitis and Crohn's disease rather than acute appendicitis and were significantly less likely to have transmural inflammation. There had been a previous appendicectomy in 3% of ulcerative colitis patients compared with 8% of colonic carcinoma specimens and 21% (P < 0.01) Crohn's disease controls.

CONCLUSION

In ulcerative colitis, as in Crohn's disease, appendiceal inflammation commonly occurs as a skip lesion and histologically resembles the colonic disease rather than acute appendicitis. The low prevalence of appendicectomy supports the hypothesis that the appendix itself may have a central role in the pathogenesis of ulcerative colitis.

Primitive neuroectodermal tumor of the kidney confirmed by fluorescence in situ hybridization

Peripheral primitive neuroectodermal tumors (PNETs) are rare lesions that form part of the Ewing family of tumors, which includes osseous and extraosseous Ewing's sarcoma and Askins tumor of the thorax. All are characterized by translocations involving the EWS gene at 22q12, usually the translocation t(11;22)(q24;12). PNETs usually occur in soft tissues but occasionally arise within a visceral organ. We describe a PNET of the kidney that showed characteristic microscopic and immunohistochemical appearances of a small, round, dark blue cell tumor with focal rosette formation and strong membrane positivity for the MIC2 gene product. Interphase fluorescence in situ hybridization on touch imprints prepared from frozen tissue using cosmid probes flanking the EWS gene at 22q12 and the FLI1 gene at 11q24 indicated the presence of t(11; = +22)(q24; = +q12), confirming the diagnosis of PNET. This is the first reported PNET of the kidney supported by cytogenetic analysis. We also review the literature on this fascinating tumor in this unusual location.

Verrucous carcinoma of the renal pelvis: case presentation and review of the literature

Squamous cell carcinoma (SCC) of the renal pelvis is an uncommon tumour that has occasionally been associated with horseshoe kidney. The verrucous form of well-differentiated SCC has not been described previously at this site. We describe such a tumour in a 41-year-old man, who presented with gross haematuria and recurrent pyelonephritis caused by staghorn calculi within a horseshoe kidney. Histology showed extensive keratinising squamous metaplasia of the pelvic urothelium with an area of verrucous acanthosis and underlying invasion of the pelvic smooth muscle by broad tongues of squamous epithelium without atypia. Local lymph nodes were not involved by tumour. Immunohistochemistry and polymerase chain reaction revealed no evidence of human papillomavirus infection. The literature regarding verrucous carcinoma of the urothelial tract is reviewed.

Alkaline encrusted cystitis associated with malakoplakia

Alkaline encrusted cystitis is a rare inflammatory condition of the bladder which has been reported sporadically over the past 80 years. It is caused by infection with urea splitting organisms leading to the deposition of inorganic salts on to the surface of the bladder. We present three cases of alkaline encrusted cystitis. In two cases the encrusted area was associated with foci of malakoplakia. The third case occurred in a patient who had received chemotherapy for acute lymphoblastic leukaemia. To our knowledge, these are the first cases of malakoplakia associated with alkaline encrusted cystitis. These two conditions have a number of clinical and aetiological similarities, and may have more in common than has been previously thought.